Finding Text
Finding #2023-002 – Material Weakness and Other Noncompliance. Applicable federal program: U. S. Department of Health and Human Services, Assistance Listing #93.959, Passed through Texas Department of Health and Human Services, Contract #’s: HHS000663700277 and HHS000663700278, Contract years: 09/21 – 08/22; 09/22 – 08/23. Applicable state program: Texas Department of Health and Human Services, Contract #’s: HHS000663700277 and HHS000663700278, Contract year: 09/21 – 08/22. Criteria: Eligibility – Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines requires that Federal Block Grant-funded SUD treatment services will be provided to all eligible Texas residents. Client eligibility for Texas residency, financial eligibility, and clinical eligibility must be performed prior to billing HHSC for SUD treatment services. Further, providers are to conduct and document in CMBHS the financial eligibility determination. If the client is unable to provide proof of financial status, the individual can attest by signing an attestation statement. Condition and context: During our testing of 40 clients for proper eligibility, three clients had documented income verification that did not meet the income guidelines specified under the grant. Despite this, services were provided to these clients, and the costs were billed to the grant. Furthermore, one client out of the 40 tested did not have proper documentation to support the financial eligibility determination, and there was no attestation statement from the client explaining the inability to provide the necessary information. Cause: The finding occurred as a result of Phoenix House not following its internal control procedures requiring review of documentation to ensure the client files are complete with eligibility documentation and that only eligible clients are being billed to the grant. Effect: Failure to follow internal control procedures resulted in incomplete client files and ineligible persons served. Questioned costs: The grant was billed $282.54 for the four clients in the billing months selected in our testing. Recommendation: Provide additional staff training to ensure internal control procedures over client eligibility and required documentation are followed. Views of responsible officials and planned corrective action: Management agrees with the finding. See Corrective Action Plan.